The Plight of India’s ASHAs

  26-Aug-2020 13:13:51

Asha workers Protest COvid-19 Healthcare
As I write this article, six lakh of India's Accredited Social Health Activists, better known as ASHAs, are sitting on astrikeall over the country.This army of all-women workers has been an imperative part of India’s famous fight against Polio and maternal mortality and is now at the vanguard as the country struggles to unfetter from the COVID-19 pandemic.

The ASHAs are demanding a hike on their niggardly monthly salary, legal status for a fixed minimum payment, PPE suits for high-risk works, and medical benefits similar to other healthcare workers deployed against the pandemic.

The strike which began on 7th August is now extended till 21st August with a failed attempt for negotiation in between.

The ASHA Programme


The ASHA Programme – ASHA means ‘hope’ in Hindi – was brought up in2005by the Ministry of Health and Family Welfare under the rubric of the National Rural Health Mission.

It was envisaged that after its full implementation by 2012, there will be an ASHA in every village of India. The vision behind the programme was to ensure better accessibility to pregnant women, the elderly and other vulnerable sections in rural homes where families felt comfortable with women workers.

According to one estimate, there are roughly900,000 ASHAstoday in India. Under the programme, an ASHA or woman health activist must be a 25-45 aged, married/widowed/divorced resident of the village she wants to serve.

Generally, unmarried women are not chosen in the program, for in the Indian culture the bride usually goes to her husband’s house after marriage which could mean changing her village or town.

An ASHA must also be at least matriculated i.e. literate up to class 10th. These conditions can be relaxed if there is no suitable literate candidate. ASHAs are selected by, paid by, and accountable to their respective Gram Panchayats.

Roles and Responsibilities


ASHAs are volunteers that bridge the government and its health policies directly to the beneficiaries. They act as an “interface between the community and the public health system”.Their work ranges from distributing iron tablets, ensuring safe pregnancies and immunization of newborns, carrying periodic checks on TB patients, and constructing sanitary latrines in villages.

On the advent of the Coronavirus malady, this has expanded to watching out for flu signs in the community, making door-to-door surveys, tracing contacts, patrolling containment zones and distributing food and medicines.They are also doubling up for local counseling and disseminating of precautionary tips and official details.

In some states, ASHAs are working for migrant workers – both Indian and NRIs. They are doing the unenviable jobs of ensuring that these travellers complete their designated quarantines while maintaining their necessary health records.

Working over 10-12 hours a day, these women are exposed to a hair’s breadth distance from the virus without any protection whatsoever.

Every ASHA visits scores of homes every day, delivers rudimentary items and verifies the basic living conditions for the migrants. Moreover, they also work hand-in-hand for municipalities and local organizations for maintaining details of the most vulnerable sections of society.

Remuneration

For all the aforementioned work they do, what do you think should be the payment for these activists? Isn’t their work during the pandemic comparable to a nurse at a government hospital?

While the averagesalaryfor such a nurse is around Rs. 20,000 per month, most ASHA workers get an average monthly remuneration of just Rs. 4000. This translates to a staggering 1/5th of the former and even this is after amajor hikelast year.

This salary is paid in concert by both the Centre and the states. Along with their monthly salaries, these workers also receive Rs. 150 for each child becoming fully immunized and Rs. 150 for each individual undergoing family planning.

To be fair, some districts did announce increased salaries for ASHAs for the surge in their workload. But in districts like Pedapalli in Telangana, even these minuscule salaries are delayed for months. Albeit regular workers have been remunerated, ASHAs have been hung out to dry.

ASHAs are designated as volunteers and are not considered employees or workers. So despite their extensive work they cannot stake their claim on a minimum income. Their work is simply thankless.

Least of Our Concerns


After so much work with so little reward, these workers don’t even get the respect they deserve from the general public let alone the government. The indifference against ASHAs has been palpable during the last few months.

“In Kozhikode, one worker’s scooter was damaged when she asked a group of men to disperse during the lockdown. Some men ask why they should listen to a woman,” said an ASHA worker from Kerala in an interview withThe Hindu.

At least 20 ASHA workers have succumbed to COVID-19. Most of these might have taken the infection from a patient they might be catering to with their service donning makeshiftdupatta-masks,without any protective equipment. The families of these workers didn’t even receive adequate compensation like that given to other health care workers across the country.

Those who recovered from the infection have reported facing immense stigma, mistrust, and heckling from the public. The institutional neglect, fear of getting infected and the public’s response have raised theapprehensions in their familieswho don’t want them to work as an ASHA anymore.

The Impact

We have not even learned from our own experiences. Innumerable researches show how the emergence of the ASHA Programme drastically changed the health status of the country. Taking a cue from one suchresearch:“after the introduction of the [ASHA] programme in 2005, there was a sharp decrease in the incidence of ‘no immunization’ and a sharp increase in the incidence of ‘full immunization’ in high-focus states, relative to non-focus states, which more or less progressed at their usual rate. For instance, there was nearly a 14 percentage-point spike in the incidence of ‘full immunization’ in high-focus states when we compare the cohort of infants born after 2005 with the cohort born just before. In contrast, for non-focus states ‘full immunization’ rates fell by around 2 percentage points.”

Another research, this by the organization Human Resources for Health, found that because of exposure to ASHA services: “Between 2005 and 2012, the use of at least one antenatal care increased from 74 to 84%, the use of a skilled attendant at birth increased from 53 to 75%, and the use of health facilities for giving birth increased from 43 to 66%.”

A study focusing on Kottayam, Kerala by Tissy Eruthickal of Baselius College has concluded that “With the introduction of ASHA there has been an evident development in the health of rural people. ASHA has been successful with its activities like the immunisation schedule of newborn babies, sanitation and various health care programs. The rural peoples are more aware about health like nutrition, basic sanitation, and hygienic practices with the commencement of ASHA. The activities of ASHA is supporting the rural peoples so that there would be an upliftment among the rural society which in turn helps in the improvement of our nation.”

Losing these workers would be a huge jolt, not only for the people they so relentlessly serve but also to our already burdened health care system. Still, it is to be seen for how long these pink-activists can soldier-on, against-all-odds, with theirdupatta-masks and their heads down.

By: Rudransh

Cover Image credits: Getty Images